Diagnose It Answer — August 23, 2026
ALL CLUES
A 47-year-old woman reports severe right upper quadrant abdominal pain that began three hours after a fried meal. She has nausea and has vomited twice since arriving.
Four prior episodes of similar postprandial pain over the past year, each resolving within a few hours. Body mass index of 34. Her mother and sister both had gallstones. No prior surgery.
HR 104, BP 138/84, RR 20, Temp 38.3 °C, SpO2 98% on room air. She is mildly tachycardic and febrile.
Marked tenderness and voluntary guarding in the right upper quadrant. Inspiration halts abruptly on deep palpation below the right costal margin. Pain radiates to the right scapula. No scleral icterus. Bowel sounds are present and normal.
WBC 16,200/µL with a left shift. Total bilirubin 1.8 mg/dL. Alkaline phosphatase 168 U/L. Lipase 32 U/L, within normal limits. Right upper quadrant ultrasound shows a wall thickness of 6 mm, pericholecystic fluid, and shadowing stones without ductal dilation.
Acute cholecystitis is cystic duct obstruction by a stone leading to gallbladder inflammation and secondary infection. The arrest of inspiration on deep right upper quadrant palpation is a positive Murphy sign, and nurses should document it deliberately because it carries high specificity. A normal lipase is the key finding that separates this from pancreatitis. Priority nursing actions are keeping the patient NPO, giving IV fluids and analgesia, and starting antibiotics. Untreated, the gallbladder can progress to gangrene and perforation within 48 to 72 hours, so escalate any rising fever or worsening pain promptly.
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